Kawashima Tomokazu, Sato Fumi
Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nish, Ota-ku, Tokyo, 143-8540, Japan.
Heart Vessels. 2017 Oct;32(10):1262-1270. doi: 10.1007/s00380-017-0993-4. Epub 2017 May 17.
The aim of this study was to document the detailed anatomy of neural course and distribution on the anterior ascending aorta, to identify the high and low density areas of the anterior ascending aortic plexus for further understandings in cardiovascular surgery. The embalmed hearts of 42 elderly individuals were submacroscopically and microscopically examined, after excluding any that were macroscopically abnormal. With its origins in the anterior ascending aortic plexus, the right coronary plexus substantially innervated the right coronary artery, the right atrium and ventricle, and the sinus node. The intensive neural area extending from 10 mm lateral to the interatrial groove below the pericardial reflection as far as the right coronary artery opening contained almost all the right coronary plexus in 61.3% of patients, and more than 40.9% of the total nerve volume of the anterior ascending aortic plexus. Our findings suggest that the most superior and lateral area on the ascending aorta show the lowest neural density of right coronary component in the anterior ascending aortic plexus and the high density areas are invisible in right lateral field of view as seen in the right trans-axillary MICS approach.
本研究的目的是记录升主动脉前方神经走行和分布的详细解剖结构，确定升主动脉前方神经丛的高密度和低密度区域，以增进对心血管手术的了解。在排除任何宏观异常的标本后，对42例老年个体的防腐心脏进行了亚宏观和微观检查。右冠状动脉丛起源于升主动脉前方神经丛，主要支配右冠状动脉、右心房和心室以及窦房结。从心包反折下方房间沟外侧10毫米处延伸至右冠状动脉开口的密集神经区域，在61.3%的患者中几乎包含了所有右冠状动脉丛，占升主动脉前方神经丛总神经体积的40.9%以上。我们的研究结果表明，升主动脉最上方和外侧区域显示升主动脉前方神经丛中右冠状动脉成分的神经密度最低，并且在右腋下微创冠状动脉搭桥术（MICS）的右侧视野中，高密度区域不可见。
